From the Guidelines
To treat hyperkalemia, calcium gluconate, insulin, and glucose can be administered, as well as inhaled beta-2 agonists like albuterol, to help lower potassium levels 1.
Treatment Options
- Calcium gluconate: 1-2 grams IV over 2-5 minutes, to rapidly reduce the membrane excitatory effects of potassium on cardiac tissue 1
- Insulin and glucose: 10 units IV with 25 grams IV over 15-30 minutes, to promote redistribution of serum potassium into the intracellular space 1
- Inhaled beta-2 agonists: 10-20 mg via nebulizer over 10-15 minutes, to help lower potassium levels 1
- Potassium-binding resins: such as Kayexalate (sodium polystyrene sulfonate), 15-30 grams orally, mixed with 100-200 mL of water, administered 1-4 times daily 1
Important Considerations
- Monitor potassium levels closely and adjust treatment accordingly 1
- Consider the use of newer K+-binding agents, such as patiromer sorbitex calcium and sodium zirconium cyclosilicate, to facilitate optimization of RAASi therapy 1
- Individualized monitoring of serum potassium is crucial, especially for patients with chronic kidney disease, diabetes, heart failure, or a history of hyperkalemia 1
From the FDA Drug Label
Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. The average total daily adult dose of Sodium Polystyrene Sulfonate is 15 g to 60 g, administered as a 15 g dose (four level teaspoons), one to four times daily.
Sodium polystyrene sulfonate can be given to treat hyperkalemia. The dose is 15 g to 60 g per day, given orally in divided doses. 2
From the Research
Treatment Options for Hyperkalemia
To treat hyperkalemia, several options are available, including:
- Calcium, insulin, and bicarbonate, which were well known to clinicians even before the introduction of cation exchange resins like sodium polystyrene sulfonate (SPS) 3
- Sodium polystyrene sulfonate (SPS), a potassium-binding resin that can be used to reduce serum potassium levels, although its effectiveness in short-term management is limited 4
- Loop diuretics and hemodialysis, which are also used to treat hyperkalemia, with hemodialysis being the most effective therapy in emergency situations 3
- New investigational potassium binders, such as patiromer and ZS-9, which have shown promise in reducing serum potassium levels and may be approved for use in the near future 3
Specific Treatments and Their Effects
- Sodium polystyrene sulfonate (SPS) can reduce serum potassium levels, but its effectiveness may be limited, with a study showing a reduction of only 0.14 mmol/L more than control 4
- SPS can also increase sodium content in enteral formulas, with a significant increase of 324% in sodium concentration found in one study 5
- The use of SPS has been associated with adverse side effects, including hypernatremia, hypokalemia, and bowel necrosis, although the incidence of these effects is relatively rare 6, 7
- Other treatments, such as insulin and bicarbonate, may also be used to treat hyperkalemia, although their effectiveness and safety profiles may vary 3
Considerations for Treatment
- The choice of treatment for hyperkalemia depends on the severity of the condition, the underlying cause, and the patient's individual needs and medical history 3
- Clinicians should be aware of the potential risks and benefits of each treatment option and use them appropriately to minimize adverse effects 6, 7
- Further research is needed to fully understand the effectiveness and safety of different treatments for hyperkalemia and to develop standardized guidelines for its management 6